경희대학교
의과대학 외과학교실, 내과학교실*, 동수원병원 일반외과**
김도균·이상목·고영관·홍성화·오수명·주홍재·
동석호*. 조광호**
Laparoscopic
Cholecystectomy after an Endoscopic Sphincterotomy for Patients with Choledocholithiasis
Do-Kyun
Kim, M.D,, Sang-Mok Lee, M.D., Young-Gwan Ko, M.D, Suug-Wha Hong, M,D,
Soo-Myung
Oh, M.D., Hoong-Zae Joo, M.D , Seok-Ho Dong, M.D* and Kwang-Ho Cho, M.D.**
Departments
of Surgery and Internal Medicine, Kyung-hee University School of Medicine;
Department
of Surgery, Dongsuwcon Hospital*
Background:
Laparoscopic cholecystectomy (LC) has become the treatment of choice for patients
with symptomatic gallbladder (GB) stones. About l0% of patients with symptomatic
GB stones may have common duct (CD) stones at the same time. For patients with symptomatic
GB stones and suspected CD stones, an endoscopic retrograde cholangiopancrcreaticography(ERCP)
should be performed. The preferred approach to these patients is an ERCP, an endoscopic
sphincterotomy(EST), and removal of the CD stones, followed by a LC. The aims of
this study were to test the safety and to evaluate the efficacy of the endoscopic
and laparoscopic procedure in patients with symptomatic GB stones associated with
CD Stones.
Material
and Methods: A retrospective review was conducted on 522 patients who had been treated
surgically for GB stones with or without CD stones between Jul. 1994 and Jun 1997
Among them, an ERCP followed by a LC was performed in 57 (67.1%) of the 85 patients
who had CD stones, a LC in 377, an open cholecystectomy in 60, and an open cholecystectomy
and CD exploration in 28
Results:
There were significant differences in operation times, hospital stays, and postoperative
complicatoins between the group with an EST followed by a LC and the group with
an open cholecystectomy and CD exploration, but no significant differences between
the LC group with an EST followed by a LC
Conclusions:
All EST followed by a LC is a good and safe treatment mordality for Patients with
symptomatic GB stones associated with CD stones.
Key
Words: Gallbladder stone, Laparoscopic cholecystectomy, Common duct stone, Endoscopic
sphincterotomy |
